According to Daria J Kuss in the 2000s, online games became popular, while studies of Internet gaming addiction emerged, outlining the negative consequences of excessive gaming, its prevalence, and associated risk factors. Internet gaming is a booming market. In 2012, more than one billion individuals played computer games, which fuelled the 8% growth of the computer gaming industry in the same year. A recent report by the market research company Niko Partners has estimated the People’s Republic of China’s online gaming market at $12 billion in 2013. In her research she stated that Internet gaming addiction has increased both in quantity as well as in quality. Research on gaming addiction dates back to 1983, when the first report emerged suggesting that video gaming addiction is a problem for students. Shortly thereafter, the first empirical study on gaming addiction was published by Shotton, based on self-reports of young male players who claimed they were “hooked” on their games. The early studies suffered from a lack of standardized psychometric instruments used for assessing gaming addiction.
Massively Multiplayer Online Role-Playing Games (MMORPGs), on the other hand, appear of particular interest to players because they offer a variety of incentives for play relative to other game genres. Of all online gamers, 46% play MMORPGs,3 confirming their position as the most popular online games. MMORPGs are game universes inhabited by thousands of players at the same time (massively multiplayer) with no spatial or temporal boundaries because they are played online, and they allow players to adopt various virtual personas in their avatars (role playing).
In South-East Asian countries, the negative impacts of Internet gaming addiction have led governments and health care providers to take the problem seriously and to develop a series of initiatives to curb and alleviate the problem. In South Korea, Internet gaming addiction is viewed as a significant concern for public health, and up to 24% of children who have been diagnosed with Internet addiction are hospitalized. In Japan, the government has recognized the problem following a study by the Ministry of Education, which has led to the development of “fasting camps” where individuals suffering from Internet and gaming addiction are helped by being cut off from technology completely. It has been stated that the higher the Internet penetration and social acceptance of gaming, the higher the prevalence of gaming problems, partially explaining the higher prevalence rates reported in South-East Asian countries.
In addition to this, there is good reason to think that the lower acceptance of excessive gaming in a culture, the more distress (not less) gamers experience in engaging in the activity, potentially fuelling problem perception. Therefore, a lack of acceptance of excessive gaming and thus stigmatization of the behavior might contribute to higher rates of addiction and problematic play in some way. Following growing concern, specialized treatment centers and programs have been established in Europe (including the outpatient clinic for behavioral addictions in Mainz, Germany, and the Capio Nightingale Hospital in London, UK) and the US (including the inpatient centers RESTART Internet Addiction Recovery Program in Seattle and the recently opened digital detoxification and recovery center in Pennsylvania), reflecting the growing need for professional help.
Internet gaming addiction is a behavioral problem that has been classified and explained in numerous ways. According to Griffiths,13 biopsychosocial processes lead to the development of addictions, such as Internet gaming addiction, which include the following components. First, the behavior is salient (the individual is preoccupied with gaming). Second, the individual uses the behavior in order to modify their mood (ie, gaming is used to escape reality or create the feeling of euphoria). Third, tolerance develops (the individual needs increasingly more time to feel the same effect). Fourth, withdrawal symptoms occur upon discontinuation of the behavior (the individual feels anxious, depressed, and irritable if they are prevented from playing). Fifth, interpersonal and intra-personal conflict develops as a consequence of the behavior (the individual has problems with their relationship, job, and hobbies, and lack of success in abstinence). Finally, upon discontinuation of the behavior, the individual experiences relapse (they reinitiate gaming).
Although the core criteria appear to be established, the etiology of Internet gaming addiction has yet to be studied in detail. Research15 indicates that a number of risk factors are associated with Internet gaming addiction. These risk factors include certain personality traits, gaming motivations, and structural game characteristics. The personality traits most commonly associated with Internet addiction include neuroticism,37,50 aggression and hostility,43,50–52 and sensation-seeking.43,50 Factors that appear to protect frequent online gamers from developing problems with their gaming were found to be conscientiousness and extraversion,53 suggesting that for different individuals the same behavior can have different psychological repercussions.
In addition to this, the following gaming motivations were found to be most commonly associated with gaming addiction: coping with daily stressors and escapism, online relationships, and mastery, control, recognition, completion, excitement, and challenge. This indicates that the reasons for game play may be an important indicator of potential risk for Internet gaming addiction. Specifically, in comparison with non-MMORPG players, MMORPG players preferred their online friends over their real-life friends. Similarly, significantly more dependent gamers were found to prefer spending time with their online friends than their offline friends relative to nondependent gamers and felt their social needs were met better online than offline. Moreover, while online games provide nonaddicted players with satisfaction, addicted players play to avoid dissatisfaction, which can be an indication of withdrawal symptoms they want to overcome by engaging in gaming compulsively.
The motivational differences to play games between dependent and nondependent as well as MMORPG and other gamers appear to be useful clinical information because these motivations can be specifically targeted in treatment sessions. For instance, elements of exposure therapy may be used for the socially fearful in order to decrease discomfort and reintroduce clients to real-life social environments. Also, alternative pastime activities that are perceived as satisfying can be encouraged specifically in group therapy sessions. Encouraging engagement in group sports might satisfy both the need to engage in competitive and satisfying activities and the need to interact with peers in real life.
Moreover, a number of structural game characteristics have been found to increase the risk for developing Internet gaming addiction, namely online relative to offline gaming,61 positive reinforcement,62 the enjoyment of particular game features, such as adult content, finding rare in-game items, and watching game cut scenes,63 and viewing one’s virtual persona as better than oneself.64 These characteristics indicate that particular games can be more addictive than others,15 which appears important for game developers and public prevention campaigns that focus on decreasing risk and raising awareness of potential problems. Prevention campaigns could target school-aged children, teachers, and parents in education settings. They could be based on the principles of providing information and a discussion platform concerning Internet and gaming use and possible negative consequences via psychoeducation, with the ultimate goal of encouraging healthy media use. Success could be determined over the long term using triangulation of data and reports obtained from the targeted populations.